Provider Demographics
NPI:1679791073
Name:PROGRESSIVE HABILITATIVE SERVICES, INC.
Entity type:Organization
Organization Name:PROGRESSIVE HABILITATIVE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUDE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-317-9996
Mailing Address - Street 1:545 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2897
Mailing Address - Country:US
Mailing Address - Phone:202-544-9057
Mailing Address - Fax:202-544-9059
Practice Address - Street 1:13629 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5095
Practice Address - Country:US
Practice Address - Phone:301-317-9996
Practice Address - Fax:301-317-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035555200Medicaid